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Publication numberEP3040034 A1
Publication typeApplication
Application numberEP20160153647
Publication date6 Jul 2016
Filing date8 Nov 2013
Priority date9 Nov 2012
Also published asCA2831045A1, EP2730235A1, EP2730235B1, US20140131418, US20170079653
Publication number16153647, 16153647.9, 2016153647, EP 3040034 A1, EP 3040034A1, EP-A1-3040034, EP16153647, EP20160153647, EP3040034 A1, EP3040034A1
InventorsStanislaw Kostrzewski
ApplicantCovidien LP
Export CitationBiBTeX, EndNote, RefMan
External Links: Espacenet, EP Register
Surgical stapling apparatus including buttress attachment
EP 3040034 A1
Abstract
A surgical stapling loading unit including a first jaw and a second jaw movable relative to one another to perform a surgical stapling operation whereby staples are fired into target tissue, the loading unit comprising: a cartridge assembly supported on one of the first jaw and the second jaw, the cartridge assembly having a tissue contacting surface defining a longitudinally extending elongate slot and a plurality of staple retaining slots, wherein the cartridge assembly includes a staple in each staple retaining slot; an anvil assembly supported on the other of the first jaw and the second jaw, the anvil assembly including an anvil plate having a tissue contacting surface defining a longitudinally extending elongate slot and a plurality of staple forming pockets; a surgical buttress releasably disposed on at least one of the tissue contacting surface of the anvil assembly and the tissue contacting surface of the cartridge assembly, the surgical buttress or buttresses including a body portion overlying the staple retention slots of the staple cartridge assembly or the staple forming pockets of the anvil assembly, the buttress or buttresses having a first flap extending from a first side edge of the body portion, and a second flap extending from a second side edge of the body portion, each flap defining a respective aperture; and a suture securing the buttress or buttresses to the cartridge assembly and/or anvil assembly.
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Claims(5)
  1. A surgical stapling loading unit including a first jaw and a second jaw movable relative to one another to perform a surgical stapling operation whereby staples are fired into target tissue, the loading unit comprising:
    a cartridge assembly supported on one of the first jaw and the second jaw, the cartridge assembly having a tissue contacting surface defining a longitudinally extending elongate slot and a plurality of staple retaining slots, wherein the cartridge assembly includes a staple in each staple retaining slot;
    an anvil assembly supported on the other of the first jaw and the second jaw, the anvil assembly including an anvil plate having a tissue contacting surface defining a longitudinally extending elongate slot and a plurality of staple forming pockets;
    a surgical buttress releasably disposed on at least one of the tissue contacting surface of the anvil assembly and the tissue contacting surface of the cartridge assembly, the surgical buttress or buttresses including a body portion overlying the staple retention slots of the staple cartridge assembly or the staple forming pockets of the anvil assembly, the buttress or buttresses having a first flap extending from a first side edge of the body portion, and a second flap extending from a second side edge of the body portion, each flap defining a respective aperture; and
    a suture securing the buttress or buttresses to the cartridge assembly and/or anvil assembly.
  2. The loading unit of claim 1, wherein the suture extends through each aperture of the flaps and wraps around the cartridge assembly and/or anvil assembly.
  3. The loading unit of any preceding claim, wherein the cartridge assembly and/or anvil assembly has a retaining feature retaining the suture to the cartridge assembly and/or anvil assembly.
  4. The loading unit of any preceding claim, wherein portions of the suture extend across distal and proximal ends of the cartridge assembly and/or anvil assembly.
  5. The loading unit of any preceding claim, wherein the suture has free ends and the free ends are tied to one another.
Description
    BACKGROUND 1. Technical Field
  • [0001]
    The present disclosure relates to a surgical stapling apparatus and, more particularly, to a surgical stapling apparatus including a detachable surgical buttress for an anvil assembly and/or a staple cartridge assembly.
  • 2. Background of Related Art
  • [0002]
    Surgical stapling instruments that are used to sequentially or simultaneously apply one or more rows of fasteners to join segments of body tissues are well known in the art. The fasteners are typically in the form of surgical staples but two part polymeric fasteners can also be utilized. Such devices generally include a pair of jaws to clamp therebetween the body tissues to be joined. Typically, one of the jaw members includes or supports a staple cartridge assembly which accommodates a plurality of staples arranged in at least two lateral rows while the other jaw member has an anvil assembly that defines a surface for forming the staple legs as the staples are driven from the staple cartridge assembly.
  • [0003]
    When the stapling instrument is actuated, longitudinally translating cams contact staple drive members in one of the jaws which in turn acts upon staple pushers to sequentially or simultaneously eject the staples from the staple cartridge assembly. A blade can travel between the staple rows to longitudinally cut and/or open the stapled tissue between the rows of staples. Such instruments are disclosed, for example, in U.S. Pat. No. 3,079,606 and U.S. Pat. No. 3, 490,675 , the entire disclosures of which are hereby incorporated by reference herein.
  • [0004]
    When stapling relatively thin or fragile tissues, it may be important to effectively seal the staple line against air or fluid leakage. Additionally, it is often necessary to reinforce the staple line against the tissue to prevent tears in the tissue or pulling of the staples through the tissue. One method of preventing tears or pull through involves the placement of a biocompatible fabric reinforcing material, or a "buttress," between the staple and the underlying tissue. In this method, a layer of buttress material is placed against the tissue and the tissue is stapled in conventional manner. In more recent methods, the layer of buttress is positioned on the surgical stapling apparatus itself prior to stapling the tissue. Some surgical staplers utilize fasteners or clips to temporarily connect buttress material to each of the jaws of the staplers, i.e., one disposed on the staple cartridge assembly and the other on the anvil assembly.
  • [0005]
    It is a desire of the present application to provide a staple line reinforcement material that is securely attached to a jaw of a stapling instrument, while being releasable therefrom. It would also be desirable to provide a staple line reinforcement material or buttress that is releasably attached to a stapler jaw by a member that is removed from the site with the stapler after use. Accordingly, it is an object of this disclosure to meet the aforementioned desires.
  • SUMMARY
  • [0006]
    The present disclosure relates to a surgical stapling apparatus including a surgical buttress.
  • [0007]
    According to an aspect of the present disclosure, a surgical stapling apparatus is provided and includes a first jaw and a second jaw movable relative to one another to perform a surgical stapling operation whereby staples are fired into target tissue. The surgical stapling apparatus comprises a housing; a handle supported by the housing; an elongated body extending distally from the housing and having a distal end adapted to releasably engage a loading unit; and a loading unit supportable on a distal end of the housing.
  • [0008]
    According to another aspect of the present disclosure, a surgical stapling loading unit including a first jaw and a second jaw movable relative to one another to perform a surgical stapling operation whereby staples are fired into target tissue is provided.
  • [0009]
    The loading unit includes a cartridge assembly supportable on one of the first jaw and the second jaw, the cartridge assembly having a tissue contacting surface defining a longitudinally extending elongate slot and a plurality of staple retaining slots formed therein, wherein the cartridge assembly includes a surgical staple loaded into each staple retaining slot. The loading unit includes an anvil assembly supported on another of the first jaw and the second jaw, the anvil assembly including an anvil plate having a tissue contacting surface defining a longitudinally extending elongate slot and a plurality of staple forming pockets.
  • [0010]
    The loading unit includes a surgical buttress releasably disposed against at least one of the tissue contacting surface of the cartridge assembly and the tissue contacting surface of the anvil assembly, each surgical buttress including a body portion configured and dimensioned to overlie the plurality of staple retaining slots and the plurality of staple forming pockets of the respective cartridge assembly and anvil assembly, the body portion defining a distal edge and a proximal edge.
  • [0011]
    The loading unit includes a length of suture securing a respective surgical buttress against the at least one of the tissue contacting surface of the cartridge assembly and the tissue contacting surface of the anvil assembly, wherein the suture extends transversely across the respective surgical buttress.
  • [0012]
    The loading unit includes a retaining feature securing each suture to the respective cartridge assembly and anvil assembly.
  • [0013]
    Portions of the continuous suture may extend across both a distal portion and a proximal portion of each surgical buttress. Portions of the continuous suture may extend across a rear surface of the respective cartridge assembly and anvil assembly. Portions of the continuous suture may be threaded through the surgical buttress along opposed sides of the surgical buttress.
  • [0014]
    The retaining feature may include an adhesive adhering the suture to a surface of the respective cartridge assembly and anvil assembly. The adhesive may adhere the suture to multiple locations along the surface of the respective cartridge assembly and anvil assembly. The adhesive may adhere a portion of the suture to the surface of the cartridge assembly at a location near the distal edge of the surgical buttress. The adhesive may adhere a portion of the suture to the surface of the anvil assembly at a location near the proximal edge of the surgical buttress.
  • [0015]
    Each surgical buttress may include a tab extending from each side edge of the body portion, and an aperture formed in each tab, wherein the suture extends through each aperture.
  • [0016]
    Each of the cartridge assembly and the anvil assembly may include a plurality of grooves formed in a side surface of the respective cartridge assembly and anvil assembly, wherein each groove is configured and dimensioned to receive a length of suture therein, and wherein grooves are formed near opposed distal side edges and opposed proximal side edges of the respective cartridge assembly and anvil assembly.
  • [0017]
    According to a further aspect of the present disclosure, a surgical staple cartridge assembly configured for use with a surgical stapling apparatus, is provided. The staple cartridge assembly comprises a staple cartridge body defining a tissue contacting surface; a central longitudinally extending knife slot formed in the cartridge body; and a plurality of longitudinally extending rows of staple retaining pockets formed in the cartridge body.
  • [0018]
    The staple cartridge assembly further comprises a surgical staple loaded in each staple retaining slots; a plurality of pushers slidably supported for vertical translation in the cartridge body and operatively associated with the surgical staples; and an actuation sled slidably supported in longitudinal translation in the cartridge body and operatively associated with the plurality of pushers.
  • [0019]
    The staple cartridge assembly also comprises a surgical buttress releasably disposed against the tissue contacting surface of the cartridge body, the surgical buttress including a body portion configured and dimensioned to overlie the plurality of staple retaining slots of the cartridge body, the body portion of the surgical buttress defining a distal edge and a proximal edge.
  • [0020]
    The staple cartridge assembly additionally comprises a continuous length of suture securing the surgical buttress against the tissue contacting surface of the cartridge body, wherein the suture extends transversely across the surgical buttress, wherein portions of the continuous suture extend across both a distal portion and a proximal portion of each surgical buttress; and a retaining feature securing the suture to the cartridge body, wherein the retaining feature includes an adhesive adhering the suture to a surface of the cartridge body.
  • [0021]
    Portions of the continuous suture may extend across a rear surface of the cartridge body. Portions of the continuous suture may be threaded through the surgical buttress along opposed sides of the surgical buttress.
  • [0022]
    The adhesive may adhere the suture along the surface of the cartridge body. The adhesive may adhere a portion of the suture to the surface of the cartridge body at a location near the distal edge of the surgical buttress.
  • [0023]
    The surgical buttress may include a tab extending from each side edge of the body portion, and an aperture formed in each tab, wherein the suture extends through each aperture.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0024]
    The present disclosure will be further described with reference to the accompanying drawings, wherein like reference numerals refer to like parts in the several views, and wherein:
    • FIG. 1 is a perspective view of a surgical stapling apparatus according to an embodiment of the present disclosure;
    • FIG. 2 is a perspective view, with parts separated, of an end effector of the surgical stapling apparatus of FIG. 1;
    • FIG. 3 is a top, perspective view of a surgical buttress of the present disclosure, shown in a planar condition;
    • FIG. 4 is a top, perspective view of a distal end of a cartridge receiving jaw of the surgical stapling apparatus of FIG. 1, illustrating the surgical buttress of FIG. 3 secured thereto a staple cartridge assembly loaded therein;
    • FIG. 5 is a cross-sectional view of the cartridge receiving jaw of FIG. 4, as taken through 5-5 of FIG. 4;
    • FIG. 6 is an enlarged view of the indicated area of detail of FIG. 4;
    • FIG. 7 is a bottom, perspective view of a distal end of an anvil jaw of the surgical stapling apparatus of FIG. 1, illustrating the surgical buttress of FIG. 3 secured thereto;
    • FIG. 8 is a cross-sectional view of the anvil jaw of FIG. 7, as taken through 8-8 of FIG. 7;
    • FIG. 9 is a top, plan view of the anvil jaw of FIG. 7;
    • FIG. 10 is a schematic, perspective view of a distal end of the cartridge assembly and the anvil assembly, illustrating an alternate embodiment of a retaining feature of the present application.
  • DETAILED DESCRIPTION OF EMBODIMENTS
  • [0025]
    Embodiments of the presently disclosed staple line reinforcement for a surgical stapling apparatus will now be described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. In the drawings and in the description that follows, the term "proximal," as is traditional, will refer to the end of the stapling apparatus which is closest to the operator, while the term "distal" will refer to the end of the apparatus which is farthest from the operator.
  • [0026]
    Referring now to FIG. 1, there is disclosed a linear surgical stapling apparatus, generally referred to as 10. In the interest of brevity, this disclosure will focus primarily on a buttress utilized in a loading unit 100, e.g., a single use loading unit ("SULU") or a disposable loading unit ("DLU"). For simplicity, hereinafter, SULU or DLU will be referred to as "DLU," but it should be understood to include either or both a DLU or SULU. An exemplary example of this type of surgical stapling instrument is disclosed in U.S. Patent No. 8,011,555 , the entire disclosure of which is incorporated by reference herein. The loading unit is removable and replaceable. Additionally or alternatively, the staple cartridge assembly can be removable and replaceable.
  • [0027]
    With reference to FIG. 1, surgical stapling apparatus 10 generally includes a handle assembly 12 and an elongate body 14 extending distally from handle assembly 12. A DLU 100 is releasably secured to the distal end of elongate body 14. DLU 100 includes a cartridge receiving jaw 102 configured to selectively receive a cartridge assembly 200 housing a plurality of surgical fasteners or staples 223 (see FIG. 4). DLU 100 further includes an anvil jaw 104, supporting an anvil assembly 300, movably secured in relation to cartridge receiving jaw 102. Handle assembly 12 includes a stationary handle member 22, a movable handle member 24, and a barrel portion 26. An articulation lever 30 is mounted on the forward end of barrel portion 26 adjacent rotatable member 28 to facilitate articulation of DLU 100. A pair of knobs 32 is movably positioned along barrel portion 26. Knobs 32 are advanced distally to approximate or close jaws 102, 104, and retracted proximally to unapproximate or open jaws 102, 104. Actuation of movable handle member 24 applies lines of staples 223 to tissue. In order to properly orient jaws 102, 104 relative to the tissue to be stapled, surgical stapling apparatus 10 is additionally provided with a rotatable member 28 on the forward end of barrel portion 26. Rotation of rotatable member 28 relative to handle assembly 12 rotates elongate body 14 and DLU 100 relative to handle assembly 12 so as to properly orient jaws 102, 104 relative to the tissue to be stapled.
  • [0028]
    As seen in FIGS. 2-4, cartridge receiving jaw 102 is dimensioned and configured to selectively receive a staple cartridge assembly 200 therein. Staple cartridge assembly 200 includes retention slots 222 formed therein for receiving a plurality of fasteners or staples 223 and pushers 226. A central longitudinal slot 234 is formed in and extends along the length of staple cartridge assembly 200 to facilitate passage therethrough of knife blade 156 of a drive bar 150 of surgical stapling apparatus 10. During operation of surgical stapling apparatus 10, an actuation sled 228 translates through staple cartridge assembly 200 to advance cam wedges of actuation sled 228 into sequential contact with pushers 226, to cause pushers 226 to translate vertically within retention slots 222 and urge staples 223 from slots 222 into staple forming pockets 312 of anvil plate 310 of anvil assembly 300 (see FIGS. 2 and 8). Reference may once again be made to U.S. Patent No. 8,011,555 , the entire disclosure of which is incorporated by reference herein, for a detailed discussion of the construction and operation of staple cartridge assembly 200.
  • [0029]
    As seen in FIGS. 4-9, at least one of cartridge receiving jaw 102 (including staple cartridge assembly 200), and anvil jaw 104 (including anvil assembly 300), includes a surgical buttress 500 operatively secured to a respective tissue contacting surface thereof.
  • [0030]
    As seen in FIG. 3, each surgical buttress 500 includes a rectangular central body portion 502 configured and dimensioned to overlie at least a portion of the staple retention slots 222 of the staple cartridge assembly 200, and staple forming pockets 312 of anvil plate 310 of anvil assembly 300. Body portion 502 defines a distal edge 502a, a proximal edge 502b, and a pair of side edges 502c, 502d.
  • [0031]
    Each surgical buttress 500 includes a first flap or tab 504a extending from a first side edge 502c of body portion 502, and a second flap or tab 504b extending from a second side edge 502d of body portion 502. Each flap 504a, 504b defines a respective aperture 506a, 506b formed therein, wherein apertures 506a, 506b are located at about a mid point of a length of body portion 502. Each flap 504a, 504b is substantially triangular in configuration. It is contemplated that buttress 500 may include a line of reduced thickness along side edges 502c, 502d to enable flaps 504a, 504b to be bent out of plane relative to a plane defined by body portion 502. The line of reduced thickness may also be used to facilitate removal of the flap or flaps from the main or body portion of the buttress.
  • [0032]
    The material from which the surgical buttress 500 is formed may be bioabsorbable or non-bioabsorbable. It should be understood that any combination of natural, synthetic, bioabsorbable and non-bioabsorbable materials may be used to form the buttress material. The buttress material may be porous or non-porous, combination of porous and non-porous layers. The non-porous buttress material may be utilized to retard or prevent tissue ingrowth from surrounding tissues thereby acting as an adhesion barrier and preventing the formation of unwanted scar tissue.
  • [0033]
    Additional exemplary materials for surgical buttresses 500 for use with the surgical stapling devices disclosed herein are set forth in commonly assigned U.S. Patent Nos. 5,542,594 ; 5,908,427 ; 5,964,774 ; and 6,045,560 , and commonly assigned U.S. Application Publication Nos. 2006/0085034, filed on April 20, 2006 ; and 2006/0135992, filed on June 22, 2006 , the entire contents of each of which is incorporated herein by reference.
  • [0034]
    In an embodiment, surgical buttresses 500 may be fabricated from a suitable biocompatible and bioabsorbable material. Surgical buttresses 500 may also be fabricated from a non-absorbent material which does not retain fluid, for example, surgical buttresses 500 may be fabricated from "BIOSYN" (a synthetic polyester, commercially available from Tyco Healthcare Group, LP d/b/a COVIDIEN, North Haven, CT), which is made from "GLYCOMER 631" (a block copolymer) which is a synthetic polyester composed of glycolide, dioxanone and trimethylene carbonate. The buttress can be a film, mesh, woven, non-woven, braided material or other material. It can be made by molding, drawing, weaving, using melt blown or spun bonding techniques or other techniques.
  • [0035]
    One block of the resulting copolymer contains randomly combined units derived from p-dioxanone (1,4-dioxan-2-one) and trimethylene carbonate (1,3-dioxan-2-one). A second block of the copolymer contains randomly combined units derived from glycolide and p-dioxanone. The resulting polyester is an ABA triblock terpolymer possessing about 60% glycolide, about 14% dioxanone, and about 26% trimethylene carbonate. Another co-polymer of glycolide trimethylene carbonate can be used to make the buttress.
  • [0036]
    Surgical buttresses 500 may be secured (i.e., from the manufacturer) onto anvil assembly 300 and/or cartridge-receiving-jaw 102/cartridge-assembly 200 combo either during the manufacturing process (i.e., pre-loaded) or prior to the surgical procedure while in the operating room. Additional or replacement surgical buttresses 500 for anvil assembly 300 and/or cartridge-receiving-jaw 102/cartridge-assembly 200 combo may be secured to either anvil assembly 300 or cartridge-receiving-jaw 102/cartridge-assembly 200 combo as needed or desired.
  • [0037]
    As seen in FIGS. 4-6, surgical buttress 500 is secured to cartridge receiving jaw 102 and to surgical cartridge assembly 200 by a length of a first suture "S1." The length of suture is desirably continuous so that only a single strand for each buttress is used. In any of the embodiments disclosed herein, more than one strand may be used to secure the buttress. With surgical buttress 500 placed against the tissue contacting surface of surgical cartridge assembly 200, such that body portion 502 of surgical buttress 500 overlies staple retention slots 222 of the staple cartridge assembly 200, first suture "S1" is used to strap, tie or otherwise secure surgical buttress 500 to the cartridge-receiving-jaw 102/cartridge-assembly 200 combo.
  • [0038]
    In particular, a first portion "S1a" of first suture "S1" is extended transversely across a distal end of staple cartridge assembly 200 (and a distal end of cartridge receiving jaw 102) in relative close proximity to distal edge 502a of surgical buttress 500. First suture "S1" is then extended to wrapped around each side of staple cartridge assembly 200 (and a distal end of cartridge receiving jaw 102) such that a pair of second portions "S1b" of first suture "S1" extend beneath staple cartridge assembly 200 (and distal end of cartridge receiving jaw 102). The pair of second portions "S1b" of first suture "S1" are crossed and then threaded through respective apertures 506a, 506b of flap 504a, 504b, such that a pair of third portions "S1c" of first suture "S1" engages respective flaps 504a, 504b. First suture "S1" is then once again extended to wrapped around each side of staple cartridge assembly 200 (and now a mid portion of cartridge receiving jaw 102) such that a pair of fourth portions "S1d" of first suture "S1" extend beneath staple cartridge assembly 200 (and mid portion of cartridge receiving jaw 102). The pair of fourth portions "S1d" of first suture "S1" are crossed and then extended to wrapped around each side of staple cartridge assembly 200 (and a proximal end of cartridge receiving jaw 102) such that the pair of fourth portions "S1d" of first suture "S1" extend above staple cartridge assembly 200 (and proximal end of cartridge receiving jaw 102). The remaining free ends "S1e" (i.e., a pair of fifth portions) of first suture "S1" are then tied or secured to one another, while extending transversely across the proximal end of staple cartridge assembly 200 (and the proximal end of cartridge receiving jaw 102) in relative close proximity to proximal edge 502b of surgical buttress 500.
  • [0039]
    In accordance with the present disclosure, a retaining feature is provided to secure first portion "S1a" of first suture "S1" in relatively close proximity to distal edge 502a of surgical buttress 500. In particular, the retaining feature may include a dab of adhesive 110 applied against staple cartridge assembly 200 (or a distal end of cartridge receiving jaw 102) at a location to adhere or secure first portion "S1a" of first suture "S1" in relatively close proximity to distal edge 502a of surgical buttress 500 prior to second portions "S1b" of first suture "S1" extending around each side and beneath staple cartridge assembly 200 (and a distal end of cartridge receiving jaw 102). Alternatively, in any of the embodiments disclosed herein, the suture may be attached to the jaw using welding, mechanical features, or other techniques. In alternate embodiments, a retaining feature may also be provided to secure fifth portion "S1e" of first suture "S1" in relatively close proximity to proximal edge 502b of surgical buttress 500.
  • [0040]
    Additionally, first portion "S1a" of first suture "S1" is adhered or secured to staple cartridge assembly 200 (or a distal end of cartridge receiving jaw 102) at a location such that first portion "S1a" of first suture "S1" extends transversely across central longitudinal slot 234 of staple cartridge assembly 200.
  • [0041]
    In accordance with the present disclosure, it is contemplated that the retaining features may include a tacking of first suture "S1" against staple cartridge assembly 200 (or a distal end of cartridge receiving jaw 102), at a location to maintain first portion "S1a" of first suture "S1" in relatively close proximity to distal edge 502a of surgical buttress 500, by a welding process or the like.
  • [0042]
    In a further embodiment, as seen in FIG. 10, it is contemplated that the cartridge assembly 200 may include a groove or notch 112a formed in each side surface of staple cartridge assembly 200 (and/or cartridge receiving jaw 102), at a location to maintain first portion "S1a" of first suture "S1" in relatively close proximity to distal edge 502a of surgical buttress 500, and which are configured to receive a segment of first suture "S1" therein. A groove or notch 112b may also be formed in each side surface of staple cartridge assembly 200 (and/or cartridge receiving jaw 102), at a location to maintain fifth portion "S1e" of first suture "S1" in relatively close proximity to proximal edge 502b of surgical buttress 500, and which are configured to receive a segment of first suture "S1" therein.
  • [0043]
    Reference may be made to U.S. Patent Application Serial No. 13/404,134, filed on February 24, 2012 , and to U.S. Patent 8,011,555 , the entire content of each of which is incorporated herein by reference, for a detailed disclosure of the configuration of groove-type or notch-type retaining features.
  • [0044]
    In accordance with the present disclosure, it is contemplated that surgical buttress 500 may be secured or tied solely to staple cartridge assembly 200. As such, a staple cartridge assembly 200, including a surgical buttress 500 secured or tied thereto, may be loaded into the cartridge receiving jaw 102 of surgical stapling apparatus 10.
  • [0045]
    As seen in FIGS. 7-9, surgical buttress 500 is secured to anvil jaw 104 by a continuous length of a second suture "S2." With surgical buttress 500 placed against the tissue contacting surface of anvil plate 310 of anvil assembly 300 (or anvil jaw 104), such that body portion 502 of surgical buttress 500 overlies staple forming pockets 312 of anvil plate 310, second suture "S2" is used to strap, tie or otherwise secure surgical buttress 500 to the anvil assembly 300 (and/or anvil jaw 104).
  • [0046]
    In particular, a first portion "S2a" of second suture "S2" is extended transversely across a distal end of anvil jaw 104 in relative close proximity to distal edge 502a of surgical buttress 500. Second suture "S2" is then extended to wrapped around each side of the anvil assembly 300 (and/or anvil jaw 104) such that a pair of second portions "S2b" of second suture "S2" extend beneath the anvil assembly 300 (and/or anvil jaw 104). The pair of second portions "S2b" of second suture "S2" are crossed and then threaded through respective apertures 506a, 506b of flap 504a, 504b, such that a pair of third portions "S2c" of second suture "S2" engages respective flaps 504a, 504b. Second suture "S2" is then once again extended to wrapped around each side of the anvil assembly 300 (and/or anvil jaw 104) such that a pair of fourth portions "S2d" of second suture "S2" extend beneath the anvil assembly 300 (and/or anvil jaw 104). The pair of fourth portions "S2d" of second suture "S2" are crossed and then extended to wrapped around each side of the anvil assembly 300 (and/or anvil jaw 104) such that the pair of fourth portions "S2d" of second suture "S2" extend above the anvil assembly 300 (and/or anvil jaw 104). The remaining free ends "S2e" (i.e., a pair of fifth portions) of second suture "S2" are then tied or secured to one another, while extending transversely across the proximal end of the anvil assembly 300 (and/or anvil jaw 104) in relative close proximity to proximal edge 502b of surgical buttress 500.
  • [0047]
    Also in accordance with the present disclosure, a retaining feature is provided to secure fifth portions "S2e" of second suture "S2" in relatively close proximity to proximal edge 502b of surgical buttress 500. In particular, the retaining feature may include a dab of adhesive 120 applied against the anvil assembly 300 (and/or anvil jaw 104) at a location to maintain fifth portions "S2e" of second suture "S2" in relatively close proximity to proximal edge 502b of surgical buttress 500 following the fifth portions "S2e" being tied or otherwise joined together above staple the anvil assembly 300 (and/or anvil jaw 104). Preferably, the dab of adhesive 120 is applied to a rear surface of the anvil assembly 300 (and/or anvil jaw 104). In alternate embodiments a retaining feature may also be provided to secure first portion "S2a" of second suture "S2" in relatively close proximity to distal edge 502a of surgical buttress 500.
  • [0048]
    Additionally, first portion "S2a" of second suture "S2" is adhered or secured to the anvil assembly 300 (and/or anvil jaw 104) at a location such that first portion "S2a" of second suture "S2" extends transversely across central a longitudinal knife receiving slot formed in the anvil plate 310 of anvil assembly 300.
  • [0049]
    In an embodiment, it is contemplated that the retaining features may include a tacking of second suture "S2" against the anvil assembly 300 (and/or anvil jaw 104) at a location to maintain fifth portion "S2e" of second suture "S2" in relatively close proximity to proximal edge 502a of surgical buttress 500, by a welding process or the like.
  • [0050]
    As seen in FIG. 10, it is contemplated that the anvil assembly 300 may include a groove or notch 114a formed in a side surface of the anvil assembly 300 (and/or anvil jaw 104), at a location to maintain first portion "S2a" of second suture "S2" in relatively close proximity to distal edge 502a of surgical buttress 500, which is configured to receive a segment of second suture "S2" therein. A groove or notch 114b may also be formed in each side surface of the anvil assembly 300 (and/or anvil jaw 104), at a location to maintain fifth portion "S2e" of second suture "S2" in relatively close proximity to proximal edge 502b of surgical buttress 500, and which are configured to receive a segment of second suture "S2" therein.
  • [0051]
    Reference may once again be made to U.S. Patent Application Serial No. 13/404,134, filed on February 24, 2012 , and to U.S. Patent 8,011,555 , the entire content of each of which is incorporated herein by reference, for a detailed disclosure of the configuration of groove-type or notch-type retaining features.
  • [0052]
    Buttresses 500 are provided to reinforce and seal staple lines applied to tissue by surgical stapling apparatus 10. Cartridge assembly 200 and anvil assembly 300 are particularly configured to allow surgical buttresses 500 to be localized on inwardly facing surfaces of cartridge assembly 200 and anvil assembly 300 in order to facilitate passage of surgical stapling apparatus 10 into the body of a patient without risk of tearing or wrinkling of the respective buttresses as surgical stapling apparatus 10 is inserted into and manipulated within the body of a patient.
  • [0053]
    In operation, with DLU 100 coupled to a distal end of elongated body 14 of surgical stapling apparatus 10, and with buttresses 500 loaded onto each of anvil assembly 300 and cartridge assembly 200, surgical stapling apparatus 10 is used in accordance with methods known by those skilled in the art. Once anvil assembly 300 and cartridge assembly 200 are clamped onto tissue, surgical stapling apparatus 10 is fired. In firing surgical stapling apparatus 10, a knife blade 156
  • [0054]
    As the knife blade 156 begins to travel distally, the knife blade 156 substantially simultaneously cuts through a central section of the fifth portions "S1e, S2e" of respective first and second sutures "S1, S2" of anvil assembly 300 and cartridge assembly 200, thereby respectively freeing the proximal ends of cartridge buttress 500a from cartridge assembly 200. Thereby loosening suture "S1" around cartridge buttress 500a. As the knife blade 156 is moved distally, the knife blade slices or cuts longitudinally through both buttresses 500, thereby dividing the buttresses 500 substantially in half.
  • [0055]
    Additionally, as the knife blade 156 approaches the distal-most position, the knife blade 156 cuts through first portion "S1a" of first suture "S1" which extends transversely across central longitudinal slot 234 of staple cartridge assembly 200 and through first portion "S2a" of second suture "S2" which extends transversely across central a longitudinal knife receiving slot 314 (see FIGS. 2 and 8) formed in the anvil plate 310 of anvil assembly 300, thereby respectively freeing the distal ends of anvil buttress 500b from anvil assembly 300. Thereby loosening sutures "S2" around anvil buttress 500b.
  • [0056]
    Since sutures "S1, S2" are adhered or otherwise secured to respective underlying components (i.e., cartridge jaw 102 and/or cartridge assembly 200, and assembly jaw 104 and/or anvil assembly 300), sutures "S1, S2" remain adhered or otherwise secured thereto following a firing of surgical stapling apparatus 10 and during a removal or withdrawal of DLU 100 from the operative site, thereby also withdrawing sutures "S1, S2" from the operative site.
  • [0057]
    In any of the embodiments disclosed herein, the sutures may comprise straps, cables, lines, tabs, belts or the like and are made from non-absorbable or bioabsorbable materials.
  • [0058]
    In any of the embodiments disclosed herein, the suture extends across the knife slot and is cut by the knife at least once. Desirably, the suture is attached to the stapler components such as the anvil assembly, cartridge assembly or channel, or both, so that each piece of the one or more pieces of suture per buttress is removed with the stapler instrument after it is fired.
  • [0059]
    While the above-described embodiments surgical staplers incorporating the use of movable knife blades to sever and release surgical buttresses from the tissue contacting surfaces of the anvil assembly and the cartridge assembly have been shown and described in relation to endoscopic surgical staplers, it is envisioned and within the scope of the present disclosure that any of the above-embodiments may be incorporated into any type of surgical stapler, including and not limited to open surgical staplers, such as, for example, linear surgical staplers and transverse surgical staplers.
  • [0060]
    It will be understood that various modifications may be made to the embodiments disclosed herein. For example, the stapling apparatus need not apply staples but rather may apply two part fasteners as is known in the art. Further, the length of the linear row of staples or fasteners may be modified to meet the requirements of a particular surgical procedure. Thus, the length of a single stroke of the actuation shaft and/or the length of the linear row of staples and/or fasteners within a disposable loading unit may be varied accordingly. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended thereto.
  • [0061]
    The invention may be described by reference to the following numbered paragraphs:-
    1. 1. A surgical stapling apparatus including a first jaw and a second jaw movable relative to one another to perform a surgical stapling operation whereby staples are fired into target tissue, the surgical stapling apparatus comprising:
      • a housing;
      • a handle supported by the housing;
      • an elongated body extending distally from the housing and having a distal end adapted to releasably engage a loading unit; and
      • a loading unit supportable on a distal end of the housing, the loading unit including:
        • a cartridge assembly supportable on one of the first jaw and the second jaw, the cartridge assembly having a tissue contacting surface defining a longitudinally extending elongate slot and a plurality of staple retaining slots formed therein, wherein the cartridge assembly includes a surgical staple loaded into each staple retaining slot;
        • an anvil assembly supported on another of the first jaw and the second jaw, the anvil assembly including an anvil plate having a tissue contacting surface defining a longitudinally extending elongate slot and a plurality of staple forming pockets;
        • a surgical buttress releasably disposed against at least one of the tissue contacting surface of the cartridge assembly and the tissue contacting surface of the anvil assembly, each surgical buttress including a body portion configured and dimensioned to overlie the plurality of staple retaining slots and the plurality of staple forming pockets of the respective cartridge assembly and anvil assembly, the body portion defining a distal edge and a proximal edge;
        • a length of suture securing a respective surgical buttress against the at least one of the tissue contacting surface of the cartridge assembly and the tissue contacting surface of the anvil assembly, wherein the suture extends transversely across the respective surgical buttress; and
        • a retaining feature securing each suture to the respective cartridge assembly and anvil assembly.
    2. 2. The surgical stapling apparatus according to paragraph 1, wherein portions of the suture extend across both a distal portion and a proximal portion of each surgical buttress.
    3. 3. The surgical stapling apparatus according to paragraph 2, wherein portions of the suture extend across a rear surface of the respective cartridge assembly and anvil assembly.
    4. 4. The surgical stapling apparatus according to paragraph 3, wherein portions of the suture are threaded through the surgical buttress along opposed sides of the surgical buttress.
    5. 5. The surgical stapling apparatus according to paragraph 4, wherein the retaining feature includes an adhesive adhering the suture to a surface of the respective cartridge assembly and anvil assembly.
    6. 6. The surgical stapling apparatus according to paragraph 5, wherein the adhesive adheres the suture to multiple locations along the surface of the respective cartridge assembly and anvil assembly.
    7. 7. The surgical stapling apparatus according to paragraph 6, wherein the adhesive adheres a portion of the suture to the surface of the cartridge assembly at a location near the distal edge of the surgical buttress.
    8. 8. The surgical stapling apparatus according to paragraph 7, wherein the adhesive adheres a portion of the suture to the surface of the anvil assembly at a location near the proximal edge of the surgical buttress.
    9. 9. The surgical stapling apparatus according to paragraph 8, wherein each surgical buttress includes a tab extending from each side edge of the body portion, and an aperture formed in each tab, wherein the suture extends through each aperture.
    10. 10. The surgical stapling apparatus according to paragraph 4, wherein each of the cartridge assembly and anvil assembly includes a plurality of grooves formed in a side surface of the respective cartridge assembly and anvil assembly, wherein each groove is configured and dimensioned to receive a length of suture therein, and wherein grooves are formed near opposed distal side edges and opposed proximal side edges of the respective cartridge assembly and anvil assembly.
    11. 11. A surgical stapling loading unit including a first jaw and a second jaw movable relative to one another to perform a surgical stapling operation whereby staples are fired into target tissue, the loading unit comprising:
      • a cartridge assembly supportable on one of the first jaw and the second jaw, the cartridge assembly having a tissue contacting surface defining a longitudinally extending elongate slot and a plurality of staple retaining slots formed therein, wherein the cartridge assembly includes a surgical staple loaded into each staple retaining slot;
      • an anvil assembly supported on another of the first jaw and the second jaw, the anvil assembly including an anvil plate having a tissue contacting surface defining a longitudinally extending elongate slot and a plurality of staple forming pockets;
      • a surgical buttress releasably disposed against at least one of the tissue contacting surface of the cartridge assembly and the tissue contacting surface of the anvil assembly, each surgical buttress including a body portion configured and dimensioned to overlie the plurality of staple retaining slots and the plurality of staple forming pockets of the respective cartridge assembly and anvil assembly, the body portion defining a distal edge and a proximal edge;
      • a length of suture securing a respective surgical buttress against the at least one of the tissue contacting surface of the cartridge assembly and the tissue contacting surface of the anvil assembly, wherein the suture extends transversely across the respective surgical buttress; and
      • a retaining feature securing each suture to the respective cartridge assembly and anvil assembly.
    12. 12. The loading unit according to paragraph 11, wherein portions of the suture extend across both a distal portion and a proximal portion of each surgical buttress.
    13. 13. The loading unit according to paragraph 12, wherein portions of the suture extend across a rear surface of the respective cartridge assembly and anvil assembly.
    14. 14. The loading unit according to paragraph 13, wherein portions of the suture are threaded through the surgical buttress along opposed sides of the surgical buttress.
    15. 15. The loading unit according to paragraph 14, wherein the retaining feature includes an adhesive adhering the suture to a surface of the respective cartridge assembly and anvil assembly.
    16. 16. The loading unit according to paragraph 15, wherein the adhesive adheres the suture to multiple locations along the surface of the respective cartridge assembly and anvil assembly.
    17. 17. The loading unit according to paragraph 16, wherein the adhesive adheres a portion of the suture to the surface of the cartridge assembly at a location near the distal edge of the surgical buttress.
    18. 18. The loading unit according to paragraph 17, wherein the adhesive adheres a portion of the suture to the surface of the anvil assembly at a location near the proximal edge of the surgical buttress.
    19. 19. The loading unit according to paragraph 18, wherein each surgical buttress includes a tab extending from each side edge of the body portion, and an aperture formed in each tab, wherein the suture extends through each aperture.
    20. 20. The loading unit according to paragraph 14, wherein each of the cartridge assembly and anvil assembly includes a plurality of grooves formed in a side surface of the respective cartridge assembly and anvil assembly, wherein each groove is configured and dimensioned to receive a length of suture therein, and wherein grooves are formed near opposed distal side edges and opposed proximal side edges of the respective cartridge assembly and anvil assembly.
    21. 21. A surgical staple cartridge assembly configured for use with a surgical stapling apparatus, the staple cartridge assembly comprising:
      • a staple cartridge body defining:
        • a tissue contacting surface;
        • a central longitudinally extending knife slot formed in the cartridge body; and
        • a plurality of longitudinally extending rows of staple retaining pockets formed in the cartridge body;
      • a surgical staple loaded in each staple retaining slots;
      • a plurality of pushers slidably supported for vertical translation in the cartridge body and operatively associated with the surgical staples;
      • an actuation sled slidably supported in longitudinal translation in the cartridge body and operatively associated with the plurality of pushers;
      • a surgical buttress releasably disposed against the tissue contacting surface of the cartridge body, the surgical buttress including a body portion configured and dimensioned to overlie the plurality of staple retaining slots of the cartridge body, the body portion of the surgical buttress defining a distal edge and a proximal edge;
      • a length of suture securing the surgical buttress against the tissue contacting surface of the cartridge body, wherein the suture extends transversely across the surgical buttress, wherein portions of the continuous suture extend across both a distal portion and a proximal portion of each surgical buttress; and
      • a retaining feature securing the suture to the cartridge body, wherein the retaining feature includes an adhesive adhering the suture to a surface of the cartridge body.
    22. 22. The staple cartridge assembly according to paragraph 21, wherein portions of the suture extend across a rear surface of the cartridge body.
    23. 23. The staple cartridge assembly according to paragraph 21, wherein portions of the suture are threaded through the surgical buttress along opposed sides of the surgical buttress.
    24. 24. The staple cartridge assembly according to paragraph 23, wherein the adhesive adheres the suture to multiple locations along the surface of the cartridge body.
    25. 25. The staple cartridge assembly according to paragraph 24, wherein the adhesive adheres a portion of the suture to the surface of the cartridge body at a location near the distal edge of the surgical buttress.
    26. 26. The staple cartridge assembly according to paragraph 25, wherein the adhesive adheres a portion of the suture to the surface of the cartridge body at a location near the proximal edge of the surgical buttress.
    27. 27. The staple cartridge assembly according to paragraph 26, wherein the surgical buttress includes a tab extending from each side edge of the body portion, and an aperture formed in each tab, wherein the suture extends through each aperture.
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Classifications
International ClassificationA61B17/072
Cooperative ClassificationA61B2017/07285, A61B2017/07271, A61B2017/07257, A61B17/07292
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